Healthcare Provider Details

I. General information

NPI: 1538142377
Provider Name (Legal Business Name): SUSAN D SCHAFFER PHD, ARNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16939 SW 134TH AVE
ARCHER FL
32618-5413
US

IV. Provider business mailing address

PO BOX 100187
GAINESVILLE FL
32610-0187
US

V. Phone/Fax

Practice location:
  • Phone: 352-495-2550
  • Fax: 352-495-3401
Mailing address:
  • Phone: 352-273-6366
  • Fax: 352-273-6568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9168271
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9168271
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: